Women Need Educating, Not Testing

A diagnosis of gestational diabetes results in the very advice which should already be given to all pregnant women — long before their glucose tolerance tests. They should eat a low GI diet, eliminate sugar and processed grains, as well as get some daily exercise. Very wise advice for all of us, regardless if we’re pregnant or not.

A recent study concluded, “A low GI diet was associated with less frequent insulin use and lower birth weight than control diets, suggesting that it is the most appropriate dietary intervention to be prescribed to patients with GDM [gestational diabetes mellitus].”

However, the vast majority of doctors and midwives are not trained nutritionists, dieticians or researchers – it’s not their job.

This means quality dietary advice often slips between the cracks, or the wrong information is given. For example, it may be suggested to use low fat milk instead of full fat. However, low fat products usually have added sugar to compensate, so everyone ends up wondering why blood sugar levels don’t improve.

Simarly to type 2 diabetes, gestational diabetes is primarily a lifestyle condition. Study after study has proven this. If you don’t cut out sugars and processed foods in your diet, it’s eventually going to catch up with you. Yes, there can be genetic inheritance, but just like some people are intolerant to gluten, those with diabetes are intolerant to sugars. So it’s important to control this with lifestyle factors, just like those with gluten sensitivity cut out gluten.

In order to have the lowest risk of gestational diabetes, a woman should have a healthy lifestyle before conception.

Recent research discovered women who ate a healthy diet, didn’t smoke, and exercised before they conceived, had a reduced risk of gestational diabetes by 83%. This is a highly significant finding — out of ten women, eight to nine cases of gestational diabetes could be preventable.

You can still reduce your risk if you adopt a healthy lifestyle during pregnancy, but the reduction is not as high, at around 50%.

But Isn’t Gestational Diabetes Due To Hormones Or The Placenta?

The biggest myth people believe about gestational diabetes is that it occurs due to being unlucky with hormones or it was the placenta. But if this were true, wouldn’t all pregnant women get it? Or is it because some women have insulin resistance already? Insulin resistance takes time to tip over the edge and has no to little symptoms.

Despite the pile of research showing significant percentages of women being diagnosed with gestational diabetes are due to dietary and lifestyle issues, this hormone belief is preventing women from knowing the truth.

Reproductive and Women’s Health Specialist, Doctor Andrew Orr says, “Yes, hormones do come into play with gestational diabetes. But insulin also affects hormones, and diet affects insulin. So diet is a big driving factor that every pregnant woman, or any woman trying to fall pregnant, needs to be aware of.”

But Can’t Gestational Diabetes Have Genetic Or Hereditary Factors Too?

Yes, it can. Factors that can increase the risks for gestational diabetes are PCOS (poly cystic ovarian syndrome, which also has significant dietary factors), being overweight, having fat in the abdominal area (apple shape), a sedentary lifestyle, consuming a high sugar and high processed food diet, genetic factors and hereditary factors.

It’s well known that a child inherits genes from the mother and father, and the way those genes are expressed (turned on) or not, are due to modifications to DNA. Research has begun to uncover the extent at which diet impacts the health of our unborn children. Researchers have found the health of the parents at conception (and even before then) can impact on what the child will be genetically predisposed to.

A recent study found a mother’s diet before she conceives can affect her unborn child’s genetic make-up and immune system. A similar study has just come out about fathers too.

Doctor Orr says, “There have been numerous studies showing the link between what happens in utero, to childhood conditions, as well as conditions that may be expressed in adulthood.”

It’s all the more reason to ensure you eat well if you’re already genetically predisposed to gestational or type 2 diabetes. It can help to break the cycle, rather than continuing to trigger the gene expression.

In Which Ways Is Gestational Diabetes NOT Diet Driven?

Is it possible to have gestational diabetes even though you have a healthy diet?

According to Doctor Orr, those who use assisted reproduction have an increased risk of gestational diabetes.

How could this be?

In study findings from the European Association for the Study of Diabetes (EASD) in 2015, they found women undergoing assisted reproductive technology were 30% more likely to be diagnosed with gestational diabetes.

Researchers were unsure as to the link between assisted reproduction and gestational diabetes, but found those in the study who were diagnosed with gestational diabetes were more likely to be overweight, have a history of gestational diabetes, have a history of miscarriage and more likely to have a family history of diabetes. Therefore, diet (and the diet of our parents) remains a dominant, underlying factor.

Doctor Orr says, “Other possible causes may be the drugs involved with reproductive medicine, which could also be messing with the pancreas [which is responsible for releasing insulin], plus many of those women have PCOS, both diagnosed and undiagnosed cases.”

Diet is critical to treating PCOS, particularly cutting out sugar and grains.

The root cause of our health problems must be investigated and addressed, or we have nothing more than a bandaid fix… and bandaids always fall off.

“But I Know Someone With Gestational Diabetes Who Is Skinny And Healthier Than Me…”

Isn’t it frustrating when you have a friend who seems to get away with everything they eat?

No matter what food or drink they consume, they don’t put on any weight. However, skinny doesn’t always mean healthy. You don’t have to be overweight to have gestational diabetes or other fertility problems, like PCOS.

Doctor Orr says, “What people need to realise is skinny people can have gestational diabetes too. It isn’t about the weight necessarily, and what some people think is healthy, may not be healthy at all. In addition, some skinny people also have PCOS, which puts them at higher risk of gestational diabetes too. Some people are simply lucky not to get gestational diabetes – it really does come down to pure luck sometimes.”

The Problem With Diet During Pregnancy

The erroneous saying “eating for two” doesn’t help the fact that many mothers-to-be think pregnancy is a free for all, as far as food and drink is concerned.

Doctor Orr says, “They don’t even consider the dangers of gestational diabetes. High GI [glycemic index] foods spike the blood sugars, which elevates the insulin — and this is where the problem lies. Remember, savoury foods and flour-based foods like bread, cereals and pasta are still sugar. It’s how they convert in the body.”

Something many people don’t realise is a bowl of pasta will spike blood sugars more than a chocolate bar, many times.

“But then, the resulting inflammation causes damage to organs and the body through oxidation. There is actually cell damage. Plus the body stores the fats, which we are now calling “obestrogens.” The resulting oestrogen dominance also causes more issues in the body — and more inflammation,” says Doctor Orr.

He continues, “Plus, the high levels of sugars and inflammation interfere with DNA and the DNA helix. It allows gene expression of conditions such as gestational diabetes. Once you express the gene, then it is damn hard to reverse that. But, we do know with genuinely low GI diets, type 2 diabetes can be reversed.”

So while the news may sound grim at first glance, there is a positive side to the story. It starts with a decision — yours — to help prevent the cycle of lifestyle conditions like gestational diabetes and type 2 diabetes… for starters.

Pregnant Women Do Need To Be Careful With Their Diets

Doctor Orr warns pregnant women to be careful with their diets during pregnancy. Even if they decide to take the OGTT (oral glucose tolerance test) during pregnancy and receive a negative result – the test isn’t known for it’s high accuracy rate.

“Pregnant women need to be very careful, because their body is already going through a great deal of change. There’s a lot of stress internally and systemically. Add in the bad sugars and the bad refined foods (which convert to sugars in the body), and the risk of gestational diabetes is increased. This then leads to an impact on the baby. The baby can have a higher risk of diabetes and cardiovascular complications later in life too. And let’s not forget, once a pregnant woman has gestational diabetes, she is also at risk of cardiovascular problems and pre-eclampsia, which are very dangerous and life threatening.”

If you also have PCOS, you are already at increased risk.

“Women with PCOS have a higher risk of type 2 diabetes through insulin resistance, and therefore when they fall pregnant, they are at increased risk of gestational diabetes. So they need to be really careful and adopt a Low GI diet long before falling pregnant, and maintain it into pregnancy,” says Doctor Orr

A recent study in China found consuming more vegetables were associated with a decreased risk of gestational diabetes, and sugar was associated with an increased risk.

Buyer Beware: Even Health Professionals Can Get Diet Advice Wrong

“When I was studying medicine, I had a total of eight hours on dietetics. At the end of eight hours, I realised I knew nothing about dietetics. I now understand why people spend four years studying to become a dietitian.” — Dr Karl Kruszelnicki

At the end of the day, simple nutrition education before and during pregnancy is key.

Doctor Orr often sees patients who have recieved incorrect advice with regards to what they can and can’t eat, in order to avoid and treat gestational (and type 2) diabetes. As a medical professional and nutritionist of 21 years who presents seminars on insulin resistance, Doctor Orr recommends the following dietary tips for those who are trying to conceive or are pregnant:

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Kelly Winder is the creator of BellyBelly.com.au, a writer, doula (trained in 2005), and a mother of three awesome children. She's passionate about informing and educating fellow thinking parents and parents-to-be, especially about all the things she wishes she knew before she had her firstborn. Kelly is also passionate about travel, tea, travel, and animal rights and welfare. And travel.

14 comments

This “article” is full of crap. I have GD and I eat a very healthy diet and I was exercising 5/6 days a week before I got pregnant. It’s not a lifestyle disease. If it were fitness instructors and women like me wouldn’t get it. Stop perpetuating stereotypes with unsupported opinions.

A heap of peer reviewed research actually backs this, saying that a heathy diet and lifestyle (including no smoking) can reduce it by up to 80% if started before conception (and around 50% during pregnancy). Is that not a significant percent? There are also other possible issues, IVF is linked to GD and diabetes in the family of origin – we now know what we eat impacts future generations, so it’s indirectly diet related. Do you have some peer reviewed research to back your claim??

Also, so many people think they eat healthy, but they are confused (understandably with conflicting information and industry organisations who sponsor nutrition organisations).

Nutritionist, not a dietitian. Stop fear mongering and making mums feel guilty when they are already upset with the diagnosis with Gestational Diabetes. While you may have had their best interest at heart when you started, this article is not helpful to them. It would be more useful to title your article how to prevent Gestational Diabetes and forget all the crap about what they could have done wrong. Make this article more positive please.

I think you need to use other researchers for your evidence. As a person who has gdm I am offended that you have all the so called evidence right there. How dare you make a statement making a pregnant mother feel worse then she already does for being diagnosed with gestational diabetes. You appear to be a person with nothing better to do the make judgements on others. Find something else to base your opinions on this is beyond your experience and you are not a dietitian or a doctor that deals with diabetes.

Doctor Andrew Orr has spent 21 years treating thousands of women with diabetes (all forms). He’s not only a doctor but a nutritionist and has a bachelor of food science, amongst others. He has written in medical journals and lectures to medical professionals as well as those pregnant or trying to conceive.

So the information is highly accurate and not sponsored by any food industry/organisation. Insulin resistance tends to be inherited, but can be prevented and controlled with a sugar and grain free diet, as well as exercise. There are loads of studies on this topic.

So if you don’t have PCOS or used IVF, are you saying that the ONLY reason a woman would get gestational diabetes is because of not exercising and eating an unhealthy diet (before and during pregnancy)?

Even if you are predisposed to insulin resistance (based on what you’ve inherited from your parents) if you don’t keep your insulin levels under control with diet and exercise, then it will be a problem. It’s not the placenta. Just like some people have gluten intolerance – diabetes is like having a sugar intolerance. And it’s controlled in the same way – avoiding the things that cause the problem.

PCOS requires the same treatment, both conditions are impacted by the foods we eat. But you don’t have to have PCOS to have GD. Even active people can have one or both conditions.

As per the article, both Doctor Orr and I agree that poor diet and lack of exercise would be the most likely trigger for GD. Unfortunately we have seen diets prescribed for GD women (we surveyed women with GD), and some recommendations are actually making it worse. Even some of the women themselves were shocked at the processed diets being recommended to them.

At the end of the day, it really does not matter how it was expressed – diet and lifestyle changes are needed to control and manage it now. It’s like asthma – lifestyle issues make it better or worse. If the diet is poorly controlled and there is lack of exercise, then it gets worse. If you get your diet under control and exercise, it gets better, so yes, diet plays and big role for sure.

I have gestantional diabetics and yes was over weight and smoked, I am finding the diet so hard as trying my best but get real hungry I’m tired all the time and feel real faint maybe u could help write some diet plans also when sugar level low is that bad

Yes unfortnately the diet given to most women isn’t good, they end up hungry and miserable. Doctor Orr and myself are currently writing a book to help women with GD, to take control in a way where they understand what’s going on, how they can feel full and also helps with insulin resistance.

We surveyed lots of women with GD, and most said they felt really informed by their doctors about their condition, but not many people got the questions right. When we asked people at the end if they would be willing to pay for something that addresses all their concerns, reduces their risks and has dietary information which makes them feel full, happy and well, the majority said they would love to know all of the information, but didn’t want to pay anything.

As you can imagine, it takes time and money to put decent information together (let alone advice from a very experienced doctor!).

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